Chest
Volume 138, Issue 6, December 2010, Pages 1500-1504
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Postgraduate Education Corner
Chest Imaging and Pathology for Clinicians
A Patient With Hearing Loss, Mediastinal Lymphadenopathy, and Cavitatory Pulmonary Nodules

https://doi.org/10.1378/chest.09-2599Get rights and content

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Case Report

A 60-year-old Chinese woman presented with complaints of progressive bilateral hearing loss over 3 months duration. There was no fever, tinnitus, headache, or ear discharge. Her medical history was significant for hypertension and hyperlipidemia, which were being treated with atenolol and simvastatin, respectively. She had no history of smoking, alcohol, or drug use. She was married with three children. Her systemic review was normal.

On examination, the patient was comfortable. She had a

Discussion

Wegener granulomatosis (WG) is a systemic vasculitis syndrome characterized by necrotizing granulomatous vasculitis of the upper- and lower-respiratory tracts, glomerulonephritis, and variable degrees of vasculitis predominantly of small arteries and veins. This condition commonly manifests as a triad of sinusitis, pulmonary infiltrates, and glomerulonephritis. A limited form of the disease is defined mainly by the absence of glomerular lesions, predominant respiratory tract involvement, and a

Conclusion

Mediastinal and hilar lymphadenopathy is a potential, but rare phenomenon in WG. The presence of these conditions should prompt the clinician to instead consider another diagnosis first, but WG should be considered in the list of differential diagnoses. The role of histologic sampling and use of an antineutrophil cytoplasmic antibody test may be helpful in this context.

Acknowledgments

Financial/nonfinancial disclosures: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

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